Summary: This testimony summarizes a June 1992 report (GAO/HRD-92-70) discussing the leadership role that states have assumed in expanding access to health insurance and containing health care costs. State approaches range from narrowly focused efforts to reform the health insurance market or control hospital costs to comprehensive initiatives to bring about universal access to health insurance. States attempting comprehensive solutions are hampered by federal program requirements, particularly Medicaid, and by the Employee Retirement Income Security Act of 1974, which preempts state regulation of employee benefit plans, including health plans provided by self-insured employers. GAO discusses state reform plans, including those in Hawaii, Minnesota, and Florida, that have been affected by federal laws. Congress may want to consider reducing the potential barriers to comprehensive state reform. Congress could spur state reform efforts by assuring the states that they will receive the federal cooperation necessary to implement change.
